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Type 1 and 2 diabetes mellitus: efficacy of anti-osteoporotic medications


Both type 1 ( T1DM ) and type 2 diabetes mellitus ( T2DM ) have been associated with bone fragility and increased fracture risk.
However, little is known regarding the effect of anti-osteoporotic treatment on bone mineral density ( BMD ) and/or fracture risk in these patients.

A research has investigated the efficacy of anti-osteoporotic medications in patients with diabetes mellitus in comparison with non-diabetic subjects.

Nine studies fulfilled the pre-defined inclusion criteria [patients with T2DM ( n = 8 ) or either T1DM or T2DM ( n = 1 ) ].
Regarding fracture risk, five studies were identified.

Alendronate ( Fosamax ) has demonstrated comparable vertebral anti-fracture efficacy in patients with and without diabetes ( n = 2 ), whereas non-vertebral fracture risk was either the same ( n = 1 ) or higher in diabetic patients ( n = 1 ).

Raloxifene ( Evista ) has also demonstrated comparable vertebral anti-fracture efficacy in both groups ( n = 2 ), without any effect on non-vertebral fractures in either group.
In one study, diabetic patients exposed to Raloxifene has demonstrated the same vertebral and non-vertebral fracture risk with non-diabetic patients.

Teriparatide ( n = 1 ) has demonstrated the same non-vertebral fracture rates in both patients with and without T2DM.

Regarding bone mineral density, equal increases in spine BMD were observed with Alendronate ( n=4), Risedronate ( n = 1 ), and Teriparatide (n = 1).
With respect to hip BMD, similar increases were observed with Teriparatide ( n = 1 ), whereas data regarding Alendronate were controversial ( n = 3 ).

No eligible study was found for Zoledronic acid, Ibandronate, Strontium ranelate, Denosumab, or Bazedoxifene.

In conclusion, the presence of diabetes does not alter anti-osteoporotic treatment response, regarding BMD increase and vertebral fracture risk reduction. ( Xagena )

Anagnostis P et al, Endocrine 2018; Epub ahead of print

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